Intersex Awareness Day

26 October 2016

Today, 26 October is Intersex Awareness Day. In honour of this important day the Being LGBTI in Asia programme wanted to provide our followers with a blog post introducing some of the UN’s ongoing work on the human rights of intersex people.

What is intersex?

“Intersex people are born with sex characteristics (including genitals, gonads and chromosome patterns) that do not fit typical binary notions of male or female bodies.”[1]

Being intersex is not about sexual orientation or gender identity and expression. It is a question of biological variation. Intersex people have the same diversity of sexual orientations and gender identities of those who do not have an intersex variation.

According to experts, up to 1.7% of the population is born with intersex traits.[2]

What are the main human rights and development issues faced by intersex people in the Asia-Pacific region?

• ‘Normalizing’ medical interventions without consent. So called ‘normalizing’ surgeries are performed in the vast majority of countries, including in the Asia-Pacific region. In many countries, particularly those with more developed medical infrastructure, doctors often advise parents to consent to surgeries and other medical interventions on their child that are aimed at ‘normalizing’ their sex characteristics. These surgeries are in most cases not medically necessary and are performed solely to make the child’s body conform to binary ideals of female or male characteristics. Such interventions may have lifelong negative ramifications on the physical and mental health of the individual.
• Data collection. There is a lack of qualitative and quantitative data on the experiences of intersex people in all areas including but not limited to access to education, employment, experiences of stigma, violence, discrimination, health violations, medical malpractice and access to justice.
• Funding. Intersex organizations are underfunded worldwide.[3] In the Asia-Pacific region nascent intersex organizations exist in Australia, China, the Philippines, Nepal and New Zealand yet rely on extremely limited funding channels.
• Networking. Intersex people often grow up in an environment of secrecy or shame and many only learn of their intersex variation at puberty or later. As a result many intersex people feel isolated and alone. Attempts to organize or network have been inhibited by this secrecy and associated stigma and shame. Activists have identified opportunities to network and meet each other as an extremely important and ongoing priority in building a strong community able to advocate for their own rights.

How do intersex issues align with development

UNDP’s vision and mission is to help countries achieve the simultaneous eradication of poverty and significant reduction of inequalities and exclusion. The Being LGBTI in Asia programme works with governments and civil society to advance inclusion, health and well-being of marginalized groups. In recognition of the extreme marginalization and wide scale invisibility of intersex people and issues, the programme strives to ensure that intersex issues are recognized and proactively integrated in relevant activities if we are to achieve our overall mission.

The principle behind the Sustainable Development Goals (SDGs) is sustainable and inclusive development for all that leaves no one behind. Intersex people are the most under serviced, under reached, under represented and under researched sub-group within the LGBTI acronym. In order to achieve truly inclusive development, explicit measures and action must be taken to mainstream and ensure the inclusivity of intersex as much as possible in programmatic and research activities.

“The inclusion of lesbian, gay, bisexual, transgender and intersex people is core to the sustainable development agenda and for human rights for all.”
- Helen Clark, UNDP Administrator, Address to the Being LGBTI in Asia Regional Dialogue on LGBTIHuman Rights and Health in Asia-Pacific, February 2015.

International law and the human rights of intersex people

Human rights are universal and indivisible. They belong to everyone without distinction, including intersex people. While no specific provision in any UN human rights treaty refers to intersex people or sex characteristics in particular, based on the principle of universality the following human rights can be identified as those primarily (but not limited to) against which intersex people experience violations: The right to recognition before the law; the right to life[4]; prohibition on torture and other inhuman or degrading treatment; right to respect for private life; and right to the highest attainable standard of health. [5]

UN documents supporting intersex inclusion:

In 2013, the then UN Special Rapporteur on Torture first discussed intersex genital mutilation in his report:

“Children who are born with atypical sex characteristics are often subject to irreversible sex assignment, involuntary sterilization, involuntary genital normalizing surgery, performed without their informed consent, or that of their parents, “in an attempt to fix their sex”, leaving them with permanent, irreversible infertility and causing severe mental suffering.”

And called upon states:

“to repeal any law allowing intrusive and irreversible treatments, including forced genital-normalizing surgery, involuntary sterilization, unethical experimentation, medical display, “reparative therapies” or “conversion therapies”, when enforced or administered without the free and informed consent of the person concerned. He also calls upon them to outlaw forced or coerced sterilization in all circumstances and provide special protection to individuals belonging to marginalized groups.”[6]

In 2014, UNDP was one of seven UN Agencies, including the WHO, that issued a joint statement on Eliminating forced, coercive and otherwise involuntary sterilization.[7]

In May 2015, the UN Office of the High Commissioner for Human Rights highlighted intersex issues in their report Discrimination and violence against individuals based on their sexual orientation and gender identity.[8] In particular, the report highlights non-consensual medical interventions.

On 14 September 2015, during the opening statement for the 30th Session of the Human Rights Council, the UN High Commissioner for Human Rights highlighted rights violations based on intersex status. Following this statement the office of the High Commissioner for Human Rights organized a specific two day Expert Meeting on ending human rights violations against intersex persons during the 30th session of the Human Rights Council.[9]

Soon after on 29 September 2015, 12 UN entities (UNDP, ILO, OHCHR, UNAIDS Secretariat, UNESCO, UNFPA, UNHCR, UNICEF, UNODC, UN Women, WFP and WHO) released an unprecedented joint statement calling for an end to violence and discrimination against lesbian, gay, bisexual, transgender and intersex people. This joint statement specifically mentions “unnecessary surgery and treatment on intersex children without their consent”.[10]

In 2015, the WHO published a report on Sexual Health, Human Rights and the Law where they stated that intersex persons should be able to access health services on the same basis as other persons without coercion. The report also highlighted that numerous human rights bodies and ethical and health professional organizations have recommended that free and informed consent should be ensured in medical interventions for people with intersex conditions, including full information, orally and in writing, on the suggested treatment, its justification and alternatives.[11]

Also in 2015, the Office of the High Commissioner for Human Rights published a Fact Sheet on Intersex as part of the UN Free & Equal Campaign.

These developments, as well as guidance provided by the UN High Commissioner for Refugees in 2011 on the treatment of LGBTI people in forced displacement, show that awareness of intersex issues and efforts to tackle human rights violations against Intersex people is an emerging trend in the UN.

Additionally, on 8 March 2016, the Special Rapporteur on torture presented his latest thematic report on gender perspectives on torture and other cruel, inhuman and degrading treatment. In this report the Special Rapporteur assessed the applicability of the prohibition of torture in international law to the unique experiences of women, girls and LGBTI persons. On intersex, the Special Rapporteur, Juan E. Méndez, recommended that states:

(i) Repeal laws that allow intrusive and irreversible treatments of lesbian, gay, bisexual, transgender and intersex persons, including, inter alia, genital normalizing surgeries and “reparative” or “conversion” therapies, whenever they are enforced or administered without the free and informed consent of the person concerned;

(ii) Prohibit and prevent the discriminatory denial of medical care and of pain relief, including HIV treatment, to lesbian, gay, bisexual, transgender and intersex persons;

(iii) Outlaw forced or coerced sterilization in all circumstances and provide special protection to individuals belonging to marginalized groups; and ensure that health-care providers obtain free, full and informed consent for such procedures and fully explain the risks, benefits and alternatives in a comprehensible format, without resorting to threats or inducements, in every case.

And just this week, in honour of Intersex Awareness day, the UN Free & Equal campaign has released the below video, and has set up a section of its website dedicated to intersex awareness.

[1] UN Free and Equal Campaign, Intersex Factsheet, 2015, available at: https://unfe.org/system/unfe-65-Intersex_Factsheet_ENGLISH.pdf [Accessed 19 April 2016].

[2] Ibid.

[3] Astraea Lesbian Foundation for Justice (2016). We are Real: The Growing Movement Advancing the Human Rights of Intersex People. New York: Astraea Lesbian Foundation for Justice, p. 29.

[4] Intersex people’s right to life may be violated by discriminatory sex selection practices, pre-implantation genetic diagnostics and other forms of testing and characteristic selection practices.

[5] UDHR, Article 6; ICCPR, Article 16; CEDAW, Article 15; and CRPD, Article 12. In addition, Article 8 of the Convention on the Rights of the Child requires states to “respect the right of the child to preserve his or her identity.”

[6] UN Human Rights Council, Report of the Special Rapporteur on Torture and other cruel, inhuman or degrading treatment or punishment, 1 February 2013, A/HRC/10/7, available at: http://www.ohchr.org/Documents/HRBodies/HRCouncil/RegularSession/Session22/A.HRC.22.53_English.pdf [Accessed 28 March 2016].

[7] OHCHR, UN Women, UNAIDS, UNDP, UNFPA, UNICEF and WHO, Eliminating forced, coercive and otherwise involuntary sterilization: An interagency statement, 2014, available at: http://www.who.int/reproductivehealth/publications/gender_rights/eliminating-forced-sterilization/en/ [Accessed 28 March 2016].

[8]UN High Commissioner for Human Rights, Discrimination and violence against individuals based on their sexual orientation and gender identity, 4 May 2015, A/HRC/29/23,available at: http://www.un.org/en/ga/search/view_doc.asp?symbol=A/HRC/29/23&referer=/english/&Lang=E [Accessed 19 April 2016].

[9] OHCHR, Opening remarks by Zeid Ra’ad Al Hussein, United Nations High Commissioner for Human Rights at the Expert meeting on ending human rights violations against intersex persons, available at: //www.ohchr.org/EN/NewsEvents/Pages/DisplayNews.aspx?NewsID=16431&LangID=E [Accessed 19 April 2016].

[10] ILO, OHCHR, UNAIDS Secretariat, UNDP, UNESCO, UNFPA, UNHCR, UNICEF, UNODC, UN Women, WFP and WHO, Joint UN statement on Ending violence and discrimination against lesbian, gay, bisexual, transgender and intersex people, 2015, available at: http://www.ohchr.org/EN/Issues/Discrimination/Pages/JointLGBTIstatement.aspx [Accessed 28 March 2016].

[11] WHO, Sexual Health, Human Rights and the Law, 2015, available at: http://apps.who.int/iris/bitstream/10665/175556/1/9789241564984_eng.pdf [Accessed 4 April 2016].